Breast CA Flashcards
(74 cards)
1
Q
what is functional part of breast
A
ducts and lobules
2
Q
3 locations of drainage -nodal
A
- axillary - most
- internal mammary
- infra/supraclavicular
3
Q
what cells surround a lobule
A
double cell layer
- inner duct-lubular- milk cells
- myoepithelial cells- muscle
4
Q
what happens to breast as ages
A
fibrous CT is replaced with radiolucent adipose tissue
5
Q
what are borders of breast exam
A
clavicle, sternum, axilla, inframammary ridge
6
Q
what to look for on breast exam
A
breast - size and shape - change in contour - color - nipple lymphatics - mass -
7
Q
**what are most breast lumps
A
majority are benign
- fibroadenoma, fibrocystic changes
- risk for CA increases with age
8
Q
** what is triple test for lump
A
- clinical exam
- biopsy
- imaging
9
Q
non-modifiable risk factors for CA
A
- age
- positive family Hx
- BRCA
- previous breast CA
- mantle radiation
- reporductive issues
- breast density
- ashkenazi Jewish
10
Q
6 modificable risk factors
A
- diet
- vitamins
- alcohol
- obesity
- sedentary lifestyles
- HRT use
11
Q
3 risk reduction strategies
A
- lifestyle mod
- suregry
- chemo
12
Q
what is effect of alcohol
A
- 5x for 3-5/day
- worse for HRT
13
Q
how can excercise help
A
some walking helps
14
Q
what is chemoprevention
A
tamoxifene daily for 5 years
15
Q
4 methods of breast screening
A
- breast awareness
- clinical breast exam
- mammography
- MRI
16
Q
what is breast awareness
A
women getting to know thair breasts so they can see what is abnormal
17
Q
when should breast exams be used
A
no longer reccomended - not good data
18
Q
when should mammogram be done
A
every 2-3 years starting at 50
19
Q
what are probs with mammography
A
- false positives
- hard to see in dense breasts
- over diagnosis of DCIS
20
Q
when to use screening MRI
A
in high risk patients
- BRCA
- chest irradiation before 30
21
Q
should we give mammography in women under 40
A
lady thinks we should if PT wants
22
Q
when to stop mammography
A
when less than 10 years life expectancy
23
Q
what to do if BRCA carrier
A
annual mam and MRI starting at 30
24
Q
when do errors occur in diagnosis
A
- self detected
- young
- negative mam
- non-lump presenting form
- preg or breast fedding
25
3 imaging modalities
1. mamm
2. MRI
3. ultrasound
26
how many images on mam
2x
1. craniocaudal
2. mediolateral
27
what is BI-RADS system
rating system in which higher scores are worse
28
4 potential things to find on mammogram
1. assymetries
2. distortion
3. masses
4. calcificaitons
29
when to use ultrasound
when can't get mamm or MRI for some reason
30
when to use MRI (4)
1. staging
2. high risk screening
3. evaluation surgical margins
4. monitoring chemo
31
what are 3 genetic factors involved in breast
1. BRCA
2. li fraumeni
3. cowden
32
what is BRCA
tumor supressor genes
| - when mutated get increased risk of carcinoma
33
what are 2 pathologic risk factors
1. proliferative breast disease
| 2. preinvasive in situ
34
what are epithelial breast lesions
wide variety of alterations that may be benign
35
how are epithelial lesions defined
1. non-proliferative
2. proliferaitve without atypia
3. proliferative with atypia
36
what are fibrocystic changes
NON-proliferative and BENIGN alterations that are very common
- often bilateral and focal
- may be painful
- maybe due to hormones
37
what is proliferative breast disease (2 types)
1. without atypia - florid ductal hyperplasia
| 2. with atypia - beginning to resemble carcinoma in situ
38
**what is key to proliferative breast disease
myoepitelial layer is preserved
39
what is DCIS
preinvasive lesion in which the lesion proliferates within the duct and myoepithelial layer is intact
- may involve the nipple
40
what is paget's disease
crrusted red nipple that may be associted with DCIS or carcinoma
41
4 features to presentation of carcinoma
1. plapable mass
2. nipple changes
3. skin changes
4. mammographic features
42
2 ways to diagnose breast carcinoma
1. cytology - fine needle biopsy - cannot diagnose invasion
| 2. histology - preferred - core biopsy
43
2 general classifications of carcinoma
1. not special type (NST) - most common
| 2. special type - better prognosis
44
3 general gene profiles of CA and prognosis
1. luminal - ER/PR+ - best prognosis
2. basal - ER/PR and Her2 -ve - poor prognosis
3. her2 - low ER/PR - poor prognosis
45
what can we give to Her2 +ve
trastuzumab - herceptin
46
when does CA not require staging
early breast CA - >5cm and no node
47
what are 2 types of surgeries
1. masectomy
| 2. lumpectomy
48
what goes with lumpectomy and why
radiation - major risk reduciton
49
what to do with sample after lumpectomy
mammogram to see if there is still calcificaitons and margin
50
what is better surgery
equivalent with radiation
51
what are 5 absolute indications for masectomy
1. multicentric
2. some collagen vascular disease
3. pt choice
4. prior radiation
5. preg
52
when is axiallary surgery done
usually onyl for CA, except DCIS with masectomy
53
why do axillary surgery
many nodes not accurately examined
| - nodal spread is prognostic
54
what is sentinal node biopsy
give blue dye and then pull out first node that should drain the area
55
who should get sentinal node biopsy (3)
1. T1,2 CA with clinically neg nodes
2. multicentric CA
3. DCIS with mastectomy
56
what to do with positive node
may not do complete dissection if:
| - post meno, had lumpectomy, systemic therapy
57
when to do chemo
depends on a variety of PT factots
58
when to radiation
always after lumpectomy
59
when in breats CA inoperable
when can't remove it all with a surgery
60
why give neo-adjuvant chemo (3)
1. assess response to chemo
2. prognostication
3. shrink tumor before
61
3 types of systemic therapy
1. chemo
2. endocrine
3. herceptin
62
how does neo adjuvant compare to adjuvant
comparable
63
who is most likely to benefit from chemo
those with a worse prognosis - more reduction in risk
64
what is best prognosic group for breast
luminal A - ER/PR+ and her2 neg
65
what is treatment for luminal A
hormones and maybe chemo (pt preference)
66
what is 21 gene recurrence score (21-RS)
cancer and reference genes that give an idea about risk
67
what is most modern and used chemp
3rd gen
68
short term SE of chemo
- hair loss
- nausea/vomiting
- mucostitis
- fatgure
- febrile neutropenia
69
long term SE of chemo -
- infert
- early menopause
- cardiomyopathy
- secondary leukemia
- neurotoxicity
70
what are 2 hormone theapry types
1. tamoxifen - block receoptos
| 2. aromatase inhibitors
71
what are adv. and dis of tomoxifen
adv: good for bones, CV risk
| dis - bad for thrombolsis, stroke, CA
72
what are adv. dis of AI
more CV risk, more lipids, more osteo
73
how long to give for
may give for 10 years for higher risk PTs
74
what are potential survivorship issues
1. hot flashes
2. vaginal dryness
3. cognitive funciton
4. fatigue
5. psychosocial impact
